tbuckley/cabot-search huggingface dataset:
Improving performance status documentation using an electronic medical record tool.
Authors: Megan Emmich, Lisa Holle
Journal: Journal of Clinical Oncology (2022)

309 Background: Performance status (PS) is used regularly in oncology care to select appropriate cancer treatment, track changes in level of functioning, and determine clinical trial eligibility. In addition, the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards requires that on each clinical encounter, staff performs and documents a patient assessment that includes 8 elements; one of which is PS. Currently, little instruction is provided on how to utilize and record a more standardized criteria, such as PS with either ECOG or Karnofsky scores, in the electronic medical record (EMR) which results in suboptimal documentation. We assessed documentation of PS before and after implementation of a tool within the EMR at our outpatient cancer center. Methods: Using the Plan-Do-Study-Act (PDSA) technique, a quality improvement project was developed to determine if our center was consistent with the ASCO/ONS guidelines. An EMR tool was developed that enabled clinicians to standardize PS documentation within an encounter via population of a flowsheet to improve compliance. Clinicians were educated on guidelines and utilization of the PS tool and data was collected pre- and post- implementation. A survey was developed and administered to assess PS tool use and to learn of any barriers to implementation. Based on survey results, we created a reminder tip sheet for clinicians to utilize the PS tool; a subsequent chart review was completed. Results: In a random pre-study 50 chart review, 0% of encounters in our lung and breast clinic had PS documented. At the time of pre-tool implementation, due to the lack of a retrievable flowsheet, we did not obtain a reliable PS documentation percentage. After education and tool implementation, 2481 random encounters were evaluated of which 315 encounters (12.6%) documented PS and used the PS tool. A total of 7 (35%) clinicians completed the survey: 4 physicians and 3 advanced practice registered nurses. Of those who responded, 57% used the PS tool, 71% used a note template with ECOG PS embedded, and 85.7% were willing to alter their note template to incorporate ECOG PS. Barriers identified included: limited time, workflow constraints and redundant documentation. After tip sheet implementation, 66% of encounters documented PS; however, only 6 out of those 33 encounters (18%) documented PS using the PS EMR tool. Conclusions: Documentation support tools help facilitate care and enable measurement of guideline concordance, but once implemented it can be challenging to maintain adherence. Although this study improved overall PS documentation (0 to 66%), we were only able to demonstrate a 6% increase in the use of our PS documentation tool. While PS tool implementation was feasible, adoption of the additional tool was not universal. We aim to gather additional clinician input to improve PS documentation completion and guideline adherence.
A pilot intervention to improve health insurance literacy and financial toxicity among recently diagnosed adolescents and young adults with cancer.
Authors: Anne C. Kirchhoff, Karely Mann, Austin R. Waters, Heydon K. Kaddas, Giselle K. Perez, Echo L. Warner, Perla L. Vaca Lopez, Nicole Ray, Amy Chevrier, Karlie Allen, Douglas Beaty Fair, Tomoko Tsukamoto, Mark Andrew Lewis, Ben Haaland, Elyse R. Park
Journal: Journal of Clinical Oncology (2022)

218 Background: Adolescents and young adults (AYAs; ages 18-39) with cancer report worries about costs and feeling uninformed about their insurance, which may impair their ability to navigate the health care system, use their insurance, and manage costs. We conducted a pilot randomized controlled trial (RCT) to assess a virtually delivered health insurance navigation intervention (“CHAT”) to improve health insurance literacy (HIL) and knowledge, increase awareness of insurance protections in the Affordable Care Act (ACA), and reduce financial toxicity and stress. Methods: CHAT is a 4-session program delivered by a patient navigator. Session content included learning about insurance, navigating your plan, insurance-related laws, &amp; managing care costs. Eligible participants had access to a wireless device, were within their first year of cancer diagnosis, and were treated at oncology sites from the University of Utah Healthcare and Intermountain Healthcare systems. We assessed feasibility and preliminary efficacy of CHAT compared to usual navigation care, including HIL (9 items on confidence using insurance), insurance knowledge (13 items on terms such as deductible &amp; copay), ACA protections (8 items), Perceived Stress Scale (PSS; 4 items), and COmprehensive Score for financial Toxicity (COST; 11 items) using t-tests. Results: From November 2020 to January 2022, 86 AYAs enrolled (46.2% approached consented); 68.6% were female, 72.1% white, 18.6% Hispanic, 34.9% age 18-25, 65.1% age 26-39, 83.7% had private insurance, and 10.5% public. Mean baseline HIL scores were 22.6 (range = 9-33, SD = 5.5). At baseline, 65.1% of participants were unaware of the ACA provision allowing appeals for coverage denials. 64.4% of intervention participants completed all 4 sessions; 86.0% completed the 5-month follow-up survey with data collection ongoing (74/86). At follow-up, compared to usual navigation care, CHAT participants had improvements in HIL, knowledge of insurance, and knowledge of ACA provisions (Table). While PSS improved more for CHAT than usual care, COST did not differ. Conclusions: Results support the feasibility and preliminary efficacy of CHAT with related improvements in HIL and knowledge of the ACA. Clinical trial information: NCT04448678. [Table: see text]
Mammographic follow-up before and during the COVID-19 pandemic.
Authors: Ritika Manik, Connor B. Grady, Sara Ginzberg, Christine E. Edmonds, Leisha C Elmore, Julia T Lewandowski, Rebecca A. Hubbard, Oluwadamilola Motunrayo Fayanju
Journal: Journal of Clinical Oncology (2022)

122 Background: Mammography adapted during the COVID-19 pandemic to accommodate social-distancing guidelines and minimize risk of exposure, but it is unclear how these accommodations potentially provoked existing inefficiencies or illuminated opportunities to redress them. The goal of this study was to compare rates of (1) diagnostic follow-up after a BIRADS 0 (i.e., incomplete) screening mammogram and (2) biopsy following a BIRADS 4 or 5 (i.e., biopsy recommended) diagnostic mammogram before and after onset of the pandemic. Methods: We included women ≥18y who underwent a BIRADS 0 screening mammogram and/or BIRADS 4-5 diagnostic mammogram at our institution from 3/15/19-3/15/21. Given seasonal variation in care receipt, pre-COVID (3/15/2019-3/15/20) and COVID (3/15/20-3/15/21) time periods were compared at a quarterly level. Case-mix adjusted associations between time-to-follow-up and COVID vs pre-COVID quarters (Q1-4) were estimated using multivariate Cox proportional hazards models. Results: We identified 17,918 women (Asian: 985, Black: 4054, Hispanic: 840, White: 11,302) who received a total of 14,388 BIRADS 0 screening and 6410 BIRADS 4 or 5 diagnostic mammograms. There were far fewer diagnostic mammograms in COVID Q1 vs pre-COVID Q1 (Table), and they were more likely to be followed up with biopsy (HR 1.21 [95% CI 1.03-1.44], p = 0.023). COVID Q3 (HR 0.92 [95% CI 0.86-0.98], p = 0.002) and Q4 (HR 0.88 [95% CI 0.83-0.95], p &lt; 0.001) screens were less likely to be followed up with diagnostic mammograms but volumes were higher vs the respective pre-COVID quarters (Table). However, COVID Q3 patients with BIRADS 4 or 5 mammograms were 18% more likely to undergo biopsy than their pre-COVID Q3 counterparts (HR 1.18 [95% CI 1.07-1.31], p &lt; 0.0001, Table) despite higher COVID volumes. Conclusions: Early in the pandemic, patients were more likely to receive mammographic follow-up, potentially due to lower patient volumes and enforced strategies for more efficient, less time-intensive care delivery. These gains were lost with regards to diagnostic follow-up for screening mammograms but maintained with regards to performing biopsies. As volumes return to or surpass pre-pandemic levels, health systems must work to identify and preserve operational efficiencies gained during the early pandemic.[Table: see text]
Process modeling radiation oncology clinic workflow from therapeutic simulation to treatment: Identifying impending strain and possible treatment delays.
Authors: Varun Chowdhry, Natalie Simpson
Journal: Journal of Clinical Oncology (2022)

39 Background: The administration of safe, high-quality radiotherapy requires the systematic completion of a series of steps from CT simulation, physician contouring, dosimetric treatment planning, pre-treatment quality assurance, plan verification, and ultimately treatment delivery. Nevertheless, due consideration to the cumulative time required to complete each of these steps is often not given sufficient attention when determining patient start date. On one hand, the nature of cancer therapy relies on timely treatment delivery. On the other hand, overly ambitious treatment turnaround times can lead to staff burnout, and result in medical errors. We sought to better understand how changes in patient volume could impact turnaround time through a simulation-based study. Methods: We developed a process model workflow for a single physician, single linear-accelerator clinic that simulated arrival rates and processing times for patients undergoing radiation treatment using AnyLogic Simulation Modeling software (AnyLogic 8 University edition, v8.7.9). We varied the new patient arrival rate from 1 to 10 patients per week to understand the impact treatment turnaround times from simulation to treatment. We utilized processing time estimates for each of the required steps as was determined in a departmental focus group study. We assumed an eight hour workday, and that contouring, treatment planning, verification, and treatment delivery followed the following distributions, respectively (in hours): triangular (2, 4, 16); triangular (8, 16, 60); triangular (0.25, 0.5, 1). Results: Altering the number of patients simulated per week from 1-10 patients resulted in a corresponding increase average processing time from simulation to treatment from 4 to 7 days. The maximum processing time for patient from simulation to treatment ranged from 6-14 days. To compare individual distributions, we utilized the Kolmogorov-Smirnov (K-S) statistical test. We found that altering the arrival rate from 4 patients per week to 5 patients per week resulted in a statistically significant change in the distributions of processing times (p = 0.03) and resulted in a corresponding increase in the maximum patient processing time from approximately 6 days to 12 days, or from approximately 1 week to 2 weeks. Conclusions: The results of this simulation-based modeling study confirm the appropriateness of current staffing levels to ensure timely patient delivery while minimizing staff burnout. However, sustained increases in volume could require increased staffing to ensure timely treatment delivery while minimizing staff burnout. Simulation modeling can help guide staffing and workflow models to ensure timely treatment delivery.
Better together: Implementation of a patient safety solution committee at an academic cancer center.
Authors: Aarti Sonia Bhardwaj, Jessica Parra, Marissa Hussa, John Mato, Brooke Tsembelis, Priya Jain, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2022)

325 Background: The Mount Sinai Health System oncology service line initiated a patient safety solution (PSS) committee to comprehensively review reported safety events in order to provide safe and high-quality care. This multi- and interdisciplinary committee creates a safe space to report events that caused harm, near misses and empowers all staff to be part of a just culture of safety. Here we describe the process and report on outcomes. Methods: The committee consists of nurses, advanced practice providers, physicians, pharmacists, social workers, IT analysts, and administrative staff, representing the oncology service line across inpatient and outpatient. Any staff member can enter incident reports that they believe warrant review into a software application. Our quality team reviews all events and then selects cases in which harm or near-harm was involved, for in-depth investigation to be presented at bi-weekly PSS meetings where cases are discussed, root causes are evaluated, and solutions are proposed. For each case, the committee votes on standard of care using the Continuous Quality Improvement (CQI) Classifications tool. Often, smaller workgroups are formed to carry out quality improvement (QI) projects and corrective action plans (CAPs). All case data, including patient demographics, case summaries, outcomes, and ongoing plans are tracked using a custom REDCap survey. A question about the role of bias was added in December 2020 (yes/no/not enough information). Results: From January 2021 until March 2022, a total of 115 events were reviewed with an average of 23 events reviewed each quarter. Sociodemographic information on patients reviewed is in table. 41% of cases involved the inpatient setting. Issues with medication comprised 47% of cases, followed by patient identification (11%) and lack of escalation (10%). The most common CAPs involved education and counselling (47%), development of new policies (22%) and escalation to leadership (8%). In total, we have developed 29 new workflows, policies, and guidelines. Bias was felt to be involved 25% of the time, no bias 5% and not enough information 43% of the time. Conclusions: This process illustrates the importance of a multi- and interdisciplinary and transparent approach to clinical case and peer review to ensure the highest level of care. The outcomes of this committee have led us to optimize current policies, create new policies and procedures, new rounding structures and place a renewed focus on bias and discrimination.[Table: see text]
Decreases in emergency department and hospitalization visits over 5 years of the Oncology Care Model.
Authors: Terry Lynn Jensen, Sabrina Q. Mikan, Holly Books, Susan Escudier, Lisa Pearson
Journal: Journal of Clinical Oncology (2022)

64 Background: In the last five years of the Oncology Care Model (OCM) our community oncology practice developed standardized processes throughout the practice to impact hospital and emergency department (ED) utilization. OCM feedback reports were evaluated and compared to practice baseline data to assess the effectiveness of these interventions in improving patient care. Within the practice continuous tracking allowed for timely reviews and process improvement. Methods: A multimodal triage approach was created, including development of individual patient treatment plans and weekly clinical team huddles where new treatment patients or high-risk patients were discussed. The “Call Us First” campaign was initiated through wallet cards. These cards were provided to patients outlining regimen details and indications for patients seeking urgent or emergent medical care. An improved triage program with Navigating Cancer (NC) reduced call back times to patients regarding patient symptoms and care needs, increased faster symptom management and decreased ED visits. Additionally, nursing check in calls were made to patients after initial chemotherapy treatments and hospital admissions. These statewide programs were rolled out through a systematic process over the first year of the OCM. Results: Admissions for the practice’s OCM patients were 22% in 2015 and decreased to 17% in 2021. For the practice’s OCM population in 2015, the baseline ED visits were 16% and decreased to 14% in late Fall 2021. Home health utilization increased from 17.9% at baseline to 22.3% after five years. Long term care days decreased from 10.7 days to 4.5 days. Skilled nursing facility days decreased from 67.6 days in 2015 to 36.80 days in 2021. By comparison, overall national OCM practices had similar declines in ED visits and hospital admissions. Conclusions: Through OCM participation there were systematic changes reducing ED visits and hospital admissions over five years. We believe that early intervention projects enable patients to avoid ED/hospital visits. Home health care visits may have contributed to less admissions. Patient outcomes were favorably impacted by the practice wide processes guided by the feedback reports. Future iterations of value-based care are undecided, and practices will build on these enhancements.
Cost-of-care analysis between patients with cancer with COVID-19 utilizing a remote patient-monitoring program versus usual care.
Authors: Joshua Pritchett, Nandita Khera, James P. Moriarty, Ruchita Dholakia, Tufia C. Haddad, Bijan J. Borah
Journal: Journal of Clinical Oncology (2022)

26 Background: We previously demonstrated that utilization of a Remote Patient Monitoring (RPM) program – characterized by the use of in-home technology for symptom and vital signs assessments with a centralized care team responding to alerts – is associated with a significant reduction in 30-day hospitalization rate among cancer patients with COVID-19. We have subsequently performed a 90-day comparative cost-of-care analysis in this prospectively enrolled, validated cohort of 71 patients who received RPM and 116 patients who received usual care without RPM. Methods: Primary outcomes included 90-day all-cause costs (categorized as hospital and outpatient costs) following the index date (date of COVID-19 diagnosis). Differences in patient characteristics and baseline costs (incurred 90 days prior to index date) were determined using Standardized Differences and controlled for using Inverse Probability Weighting (IPW). IPW balancing was based on baseline covariates known to be associated with poorer COVID-19 outcomes, as previously described. Association of costs with RPM was examined by generalized linear modeling while adjusting for relevant variables. Outcomes are reported as the average treatment effect on the treated (ATET). Results: Differences in patient characteristics and baseline costs were well-balanced following IPW modeling. The index ATET was found to be comparable among patients receiving RPM and usual care on the date of COVID-19 diagnosis -$89.75 (95% CI: -$144.33 to $323.84; p = 0.452). However, patients receiving RPM experienced a 90-day ATET of -$6,994 (95% CI: -$14,635 to $646; p = 0.073) when compared with patients receiving usual care. Conclusions: There was a trend towards decreased 90-day all-cause costs for cancer patients with COVID-19 who utilized the RPM program as compared with usual care. Larger studies are needed to understand the true cost (and cost savings) associated with this innovative model of care delivery which can be leveraged for cancer care beyond COVID-19.
Understanding feasibility and patient experiences with a ride share program to facilitate uninsured, Hispanic participation in clinical trials: A pilot survey study.
Authors: Jhenitza Raygoza, Robert Rosenblatt, Jessica Austin, Farhia Omar, Idali Cuellar, Donald W. Northfelt, Etta Pisano, Bhavika K. Patel
Journal: Journal of Clinical Oncology (2022)

91 Background: Most screening clinical trials are not representative of the populations susceptible to disparities in breast cancer outcomes. Strategies are needed to address known structural barriers to clinical trial participation. We partnered with a federally qualified health center to provide no-cost ride-share services as a strategy to facilitate enrollment of uninsured, Hispanic women in Maricopa County, Arizona into a national trial offering no-cost mammography screening. Objective: This pilot survey study explored the feasibility and experiences of uninsured, Hispanic women with a no-cost ride share program as part of the National Cancer Institute funded ECOG-ACRIN clinical trial, TMIST, studying mammography screening at the Mayo Clinic Arizona in Phoenix. Methods: Participants completed a validated survey by phone and interview-style. Survey items assessed women’s use of and experiences with the ride share service including barriers, benefits, and if the ride share service facilitated their participation in the screening trial. Descriptive statistics were calculated using SAS. Results: A total of 30 women completed the survey (response rate = 30/33). All women first-time Mayo Clinic trial participants and 90% lived at least 30 minutes away from trial facility. The mean age of women was X years, 90% had a high school degree or less, and 97% were Spanish speaking. Most women (73.7%) said that travel distance was a barrier to participation in prior clinical trials. A large proportion of women (73%) reported using ride share services for this trial and all agreed that the ride service made it easier for them to attend their trial visit. Nearly 1/3 (64%) said that they were uncertain or would not have been able to participate without the ride-share as an option. Among women using the ride share service, the main benefits of the program included at-home pick up and the service being of no-cost. Other benefits included flexible timing (86%) and one-on-one service (86%). The primary barrier of the program was the driver not speaking the dominant native language (27.3%). Conclusions: Despite lengthy travel distances, women reported overwhelming positive experiences with the no-cost ride share program and agreed that the service helped facilitate their participation in the clinical trial. Thus, no-cost ride share programs are a promising and feasible strategy to reduce barriers to clinical trial participation among historically underserved populations. Future studies should continue to explore the benefits and sustainability of ride-share programs, including benefits to clinical trial retention.